We carried out this comprehensive inspection on 18, 19 and 22 May 2017.

Advance Housing and Support provides a supported living service to adults with learning disabilities across 11 sites in East London and Kent. At the time of our inspection there were 47 people using the service, of whom 44 people lived in the supported living services.

At our last inspection in March 2016 we rated the service “good”, but made a recommendation about how the service monitors medicines and people’s finances. At this inspection we found that the provider had made improvements in this area, and remained “good.”

The provider had made improvements to ensure that people received their medicines safely and that systems were in place to audit the management of people’s finances.

The provider had measures in place in order to safeguard people from abuse and manage risks to individuals. We saw that when allegations and complaints were made, these were investigated by managers and appropriate action was taken in response. There were detailed plans in place for assessing and mitigating risks to individuals. This included the use of positive behavioural support plans to enable to staff to manage and prevent episodes of behaviour which may challenge.

Care plans were person centred and contained detailed information about people’s needs and wishes. The provider had clear guidelines in place for people to ensure they were supported in the way that they wanted and to ensure that care was effective. People received support to eat healthily in a manner of their choice, and we saw that staff supported people to maintain good health through health action plans, and working with other health professionals.

Staff understood how best to communicate with people, and this was aided through communication passports and detailed information on how best to support people to speak up. The provider used daily records, tenants meetings and other methods for consulting people about their care. There were systems of audits completed by managers to ensure that services were safe and that care was delivered appropriately. Staff were recruited in line with safer recruitment measures, and staffing levels were in line with people’s support plans.

People had consented to their care, and when people lacked capacity to do so the provider met its responsibilities to assess people’s capacity and demonstrate that they were acting in people’s best interests. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received appropriate levels of supervision and benefitted from a detailed induction programme. Staff were required to undergo regular refresher training in key areas, however in some areas staff had not had this on time, and systems didn’t always allow managers to detect when this had happened. We have made a recommendation about this.

This inspection took place on 22 and 30 March 2016 and was announced. At our last inspection on 16 September 2014 the service was meeting the regulations we checked.

Advance Housing and Support is a supported living service for people with learning disabilities who live in their own homes in the community. At the time of our inspection, the service was providing care and support to 37 people, of whom 33 lived in one of 11 supported living services with an onsite office.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider used person centred planning and accessible communications to ensure that people’s support met their needs and wishes. Where people did not have capacity to make decisions about their care and support, we could see that they were still involved as much as possible in the process and that staff were working in line with people’s best interests. We saw that people were supported to make day to day choices and people’s dignity was promoted and respected by staff.

Risks to people were assessed and reviewed regularly, and measures put in place in order to manage risks, such as choking and people who may be at risk of injury. The provider used safer recruitment processes and checking of financial records to reduce the risk that people may be abused. We saw that staff had a good awareness of their responsibilities to safeguard people. Relatives we spoke with felt that the service was safe and had never had a concern about their family member’s wellbeing or safety.

Staff had received adequate training to allow them to carry out their roles. We saw that staff were skilled at supporting people, including people with behaviour which may challenge the service. This was done through the use of positive behaviour support plans and appropriate levels of support to keep people and others safe. People were supported through health action plans to maintain good health and nutrition and the provider worked closely with health professionals to maintain good health. Where people were at risk of malnutrition or dehydration, staff monitored people’s food and fluid intake and managed these risks appropriately.

The provider had a detailed system of audits for maintaining good quality care which kept people safe. Medicines were recorded and managed appropriately, however in a small number of cases we found discrepancies in medicines records which had not been detected by audits.

People and their relatives were confident that they knew who to speak with if they had a complaint or a concern, and we saw that these were addressed appropriately in a timely manner. Staff were able to demonstrate that they met people’s needs on a daily basis, and we saw that the provider adapted and responded to people’s changing needs. There was an open and positive culture between managers, staff, people who use the service and their relatives. This was maintained through good communication and regular staff meetings and supervision, as well as maintaining a strong management presence on each site.

We have made a recommendation about how the service carries out audits of how people’s medicines are administered and recorded.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

There were 32 people receiving the regulated activity of personal care at the time of our visit. We spoke with six relatives of people who used the service. We spoke with the provider and three members of staff. We reviewed care records for people who used the service and records relating to the management of the service, which included four staff files.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

The relatives we spoke with told us they felt their family member was safe with care workers. There were good recruitment procedures in place, ensuring the safety of people receiving care was fully considered. Staff experience and expertise was fully considered and there had been staff training in the past year, which included safeguarding adults.

There were up to date care plans in place for each person and there was evidence potential or actual risks had been assessed and plans put in place to manage such risks. Care plans included details of health professionals involved in the delivery of each person’s care.

Is the service effective?

People who used the service or their relatives were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "I always give choices; if the client is non-verbal I use photos." We were also told Makaton, a form of sign language was used to communicate with people." We saw records staff were being observed by the provider to ensure they were caring for people with dignity.

Is the service caring?

Staff told us how they cared for the people who used the service, working to meet the needs of people as individuals. A relative told us, "X is so calm now she has joined the service. She seems happy and is being looked after well." Another relative told us “They are OK.” People’s rights were respected and staff were able to describe how they treated people in a dignified and caring manner.

Is the service responsive?

People’s individual needs had been assessed by suitably experienced staff. The staff we spoke with were aware of the needs of people who used the service and how to meet their care needs. The relatives we spoke with told us they were aware of how to make a complaint. The provider told us no complaints had been received in the past year.

Is the service well-led?

Staff told us they had regular staff meetings with the provider and also had spot checks. Written feedback had not been obtained from people who used the service in the past year. Meetings were being held monthly within the service for the people and their relatives to attend.

The people we spoke with at the time of our inspection told us they were happy with the care they received. One person said, “I’m very happy. The staff look after me.” One relative told us, “the staff are very nice. I’ve heard them talk to my relative very kindly.”

People who used the service were asked for their consent to the care they received. This was reviewed on a regular basis. There were systems in place to obtain consent from family or advocates if people did not have the mental capacity to understand.

There were suitable arrangements in place to ensure people using the service were safeguarded against the risks of abuse.

Staff received appropriate professional development. They were able to obtain further qualifications relevant to their job. Staff told us they felt supported in their role.

The provider had an effective system to assess and monitor the quality of service that people receive.

People who used the service were supported to be independent and had choices in their daily lives. People’s needs were assessed and their support plans identified the actions needed to meet their individual needs. People were consulted about their service and were involved in decisions about their care. People said the service met their needs, that they were happy with the way their outreach workers supported them and had no complaints.